Viability and thresholds for treatment of extremely preterm infants: survey of UK neonatal professionals.

BACKGROUND: Decisions about treatments for extremely preterm infants (EPIs) born in the 'grey zone' of viability can be ethically complex. This 2020 survey aimed to determine views of UK neonatal staff about thresholds for treatment of EPIs given a recently revised national Framework for Practice from the British Association of Perinatal Medicine. METHODS: The online survey requested participants indicate the lowest gestation at which they would be willing to offer active treatment and the highest gestation at which they would withhold active treatment of an EPI at parental request (their lower and upper thresholds). Relative risks were used to compare respondents' views based on profession and neonatal unit designation. Further questions explored respondents' conceptual understanding of viability. RESULTS: 336 respondents included 167 consultants, 127 registrars/fellows and 42 advanced neonatal nurse practitioners (ANNPs). Respondents reported a median grey zone for neonatal resuscitation between 22+1 and 24+0 weeks' gestation. Registrars/fellows were more likely to select a lower threshold at 22+0 weeks compared with consultants (Relative Risk (RR)=1.37 (95% CI 1.07 to 1.74)) and ANNPs (RR=2.68 (95% CI 1.42 to 5.06)). Those working in neonatal intensive care units compared with other units were also more likely to offer active treatment at 22+0 weeks (RR=1.86 (95% CI 1.18 to 2.94)). Most participants understood a fetus/newborn to be 'viable' if it was possible to survive, regardless of disability, with medical interventions accessible to the treating team. CONCLUSION: Compared with previous studies, we found a shift in the reported lower threshold for resuscitation in the UK, with greater acceptance of active treatment for infants <23 weeks' gestation.

Construcción y validación de un instrumento para medir conocimientos de madres y cuidadores sobre alimentación complementaria de infantes / Construction and validation of an instrument to measure knowledge of mothers and caregivers on complementary feeding of infants

INTRODUCCIÓN: La nutrición adecuada durante los primeros dos años de vida es fundamental para el desarrollo pleno del potencial del ser humano. La introducción inadecuada, precoz o tardía de la alimentación complementaria trae consecuencias a corto y largo plazo. La alimentación complementaria depende en gran medida de los conocimientos del cuidador que en los países de Latinoamérica generalmente es la madre. OBJETIVO: construir y validar un instrumento para medir los conocimientos maternos y de cuidadores sobre alimentación complementaria. SUJETOS Y MÉTODO: Estudio de observación. Participaron 80 madres comunitarias y 12 pediatras expertos. Se desarrolló en dos etapas: la creación del instrumento a partir de las 7 fases propuestas por Sampieri, y la validación mediante la evaluación de validez aparente, de constructo, de contenido, consistencia interna y fiabilidad intra-observador. RESULTADOS: Se creó un instrumento autoadministrado que incluyó inicialmente 14 preguntas sobre conocimientos maternos y de cuidadores. Durante la validación de constructo se identificaron 3 dominios y se eliminaron cuatro preguntas. En la validación de contenido, 10 preguntas del instrumento definitivo obtuvieron calificaciones superiores a 9 (en una escala de 0-10) en las características: calidad, vocabulario, relevancia y actualidad. La consistencia interna global del instrumento fue moderada (Alfa de Cronbach: 0,64) y la fiabilidad intra-observador fue aceptable (k: 0,21-0,40) para el 80% de ítems del instrumento. CONCLUSIONES: Se presenta el primer instrumento autoadministrado validado en la región, que permite medir conocimientos de las madres y los cuidadores sobre alimentación complementaria. A futuro, permitirá diseñar y desarrollar estrategias de evaluación e intervención en relación con los conocimientos maternos y de los cuidadores sobre alimentación complementaria.

INTRODUCTION: Adequate nutrition during the first two years of life is crucial for the full development of human potential. Inadequate, early, or late introduction of complementary feeding has consequences in the short- and long-term. Complementary feeding depends largely on the knowledge of the caregiver who, in Latin American countries, is usually the mother. OBJECTIVE: To create and validate an ins trument to measure knowledge about complementary feeding. SUBJECTS AND METHOD: Observational study in which 80 community mothers and 12 expert pediatricians participated. It was carried out in two stages, the creation of the instrument (following the 7 phases proposed by Sampieri) and the va lidation through the evaluation of the apparent validity, construct and content validity, internal con sistency, and intra-observer reliability. RESULTS: A self-administered instrument was created that ini tially included 14 questions about maternal and caregiver's knowledge. During the validation of the construct, 3 domains were identified and four questions were eliminated. In the content validation, 10 questions of the final instrument scored higher than 9 (on a scale of 0-10) in the characteristics of quality, vocabulary, relevance, and topicality. The global internal consistency of the instrument was moderate (Cronbach's alpha: 0.64) and the intra-observer reliability was acceptable (k: 0.21-0.40) for 80% of its items. CONCLUSIONS: the first self-administered instrument validated in the region to measure the knowledge of mothers and caregivers about complementary feeding is presented. It will allow to design and develop strategies in relation to maternal and caregiver's knowledge of comple mentary feeding.

[Factors associated with the anxiety level and knowledge about childcare and lactation in first-time pregnant women]. / Factores asociados al nivel de ansiedad y de conocimientos sobre puericultura y lactancia de embarazadas primerizas.

OBJECTIVE: To know the level of anxiety and knowledge of childcare and lactation of the current pregnant women, and the clinical-demographic variables with which they are related. DESIGN: Cross-sectional study. SETTING: Seven health centers of Area V (Asturias). PARTICIPANTS: First-time pregnant women who completed preparatory courses from 01.06.2015 to 31.10.2015, excluding multiple gestation, risk pregnancy, contraindicated breastfeeding and language problems. INTERVENTIONS: Sociodemographic variables questionnaire, STAI state anxiety questionnaire and 23 questions about childcare and lactation. MAIN MEASUREMENTS: We performed descriptive and multivariate analysis (program R) of the variables of the questionnaire. RESULTS: We captured 104 pregnant women; average age 34.2(SD: 4.5), 94.2% Spanish, 61.5% university, 17.3% smokers in pregnancy, 23.1% with psychopathological antecedents; 88.4% planned to give breastfeeding. The mean STAI-S was 18.1(SD: 7.4) and scored 4.5(SD: 2.3) mean errors. The most faulty ones were on causes of fever (56.7%), fever measurement (54.8%) and physiological stools (55.7%). The multivariate analysis between knowledge and profile showed statistically significant associations with: being foreign, university, pregnancy planning and matron. In relation to the STAI-S was significant for being a smoker, receiving breastfeeding, psychopathological antecedents and matron. CONCLUSIONS: The current pregnant women who complete preparatory courses are mainly mature, university and Spanish. They have good concepts about breastfeeding but many are unaware of basic concepts of fever and stool of the infant. Foreign mothers with unwanted pregnancy and primary education seem to have more confusing concepts. Smoking mothers with psychopathological antecedents and who have not received breastfeeding present more anxiety. The matron significantly influences anxiety and acquired concepts.

Ética e estética do cuidado nos primórdios da vida: reinventando a prática cotidiana com bebês numa unidade de acolhimento / Ethics and aesthetics of care in the early days of life: reinventing everyday practice with babies in a care unit

Esta tese é resultado de uma pesquisa-intervenção realizada na Zona Sul da cidade do Rio de Janeiro, em uma Unidade de Acolhimento para bebês entre 0 e 36 meses. Nesse contexto, analisei a importância de uma ética do cuidado em relação à primeiríssima infância, o que significou incluir no estudo o profissional cuidador e a instituição que une os atores, bebês e adultos. Também investiguei a qualidade do cuidado ofertado aos bebês no berçário desse abrigo municipal, exatamente no momento em que os gestores desejavam realizar uma mudança estrutural na dinâmica do trabalho das educadoras sociais. O estudo constou de três passos metodológicos e práticos. Em primeiro lugar, a modificação paradigmática do modo de cuidar foi sendo construída ao longo do tempo, tendo amparo num coletivo denominado Roda de Conversa, quando se passou a falar sobre os problemas enfrentados no cotidiano, especialmente sobre a relação com os bebês e os familiares. As comunicações foram convergindo no sentido de que o bebê precisava de uma relação de referência que lhe assegurasse uma atenção recíproca e amorosa. A partir da interlocução entre a psicanálise e a abordagem Pikler, foi discutido no trabalho um modelo de intervenção que visava favorecer tanto a constituição psíquica dos bebês quanto o cuidado com o cuidador. Para isso, foi ofertado às educadoras, nesse primeiro momento, o referido espaço de fala onde se processavam as angústias que a atividade de cuidar suscita e onde havia uma mútua apropriação das sutilezas da função que elas exercem. Num segundo momento, a pesquisa passou a ser desenvolvida no berçário da instituição e focou-se, de um lado, na observação das relações cotidianas de cuidado entre adultos e crianças, sendo inspirada no método de observação da psicanalista Esther Bick; de outro, nas narrativas das educadoras que foram selecionadas para serem acompanhadas em profundidade e que participaram de uma conversa com a pesquisadora, ao final de cada observação. Essa última atividade se fundamentou na construção clínica da intervenção a tempo e da abordagem da psicossociologia francesa. Num terceiro momento, a equipe técnica foi entrevistada, de forma aberta e sem um instrumento de condução da fala, sobre as relações internas e externas de cada uma. O objetivo foi compreender de que modo essas pessoas, responsáveis institucionais, viam a dinâmica de seu trabalho e a forma como o exerciam, considerando que as dimensões sociais, individuais, subjetivas, intersubjetivas, conscientes e inconscientes, imaginárias e simbólicas nas instituições produzem efeitos na qualidade do que é produzido. Dessa forma, estão no centro da investigação as relações intersubjetivas e seus efeitos nas relações de cuidado, tendo como eixo teórico os trabalhos desenvolvidos por B. Golse e D. Stern sobre os primórdios da subjetivação, assim como o modelo metapsicológico proposto por Winnicott sobre as relações iniciais cuidador/bebê, a teoria psicanalítica sobre os processos intersubjetivos/grupais, a psicodinâmica do trabalho e a abordagem psicossociológica francesa. Considerando as funções do cuidado como um eixo primordial para o processo de subjetivação dos bebês e para o desenvolvimento da capacidade da educadora de estabelecer vínculos de qualidade com os pequenos, o trabalho destacou as dimensões sensíveis do bebê e do adulto, e a necessidade de as instituições considerarem esses elementos invisíveis como veículo para o processo de humanização de todos. Concluo que esse estudo corrobora para o entendimento de que, para um trabalho de qualidade no âmbito do cuidado com bebês aconteça é fundamental que o cuidador tenha a capacidade de se autorregular emocionalmente e de cuidar de si. Para isso, exemplarmente, nesse tempo da pesquisa, as educadoras e a equipe técnica produziram um espaço para a invenção de si e do mundo ao qual pertencem

This thesis is the result of an intervention research conducted in Zona Sul, the southern part of the city of Rio de Janeiro, in a care unit for babies between 0 and 36 months. In this context, I analyzed the importance of an ethics of care in relation to the very first childhood, which meant to include in the study the professional caregiver and the institution that unites the actors, babies and adults. I also investigated the quality of care offered to the babies in the nursery of this municipal shelter, just at the moment when managers wanted to make a structural change in the work dynamics of social educators. The study consisted of three methodological and practical steps. In the first place, the paradigmatic modification of the way of caring was built over time, taking shelter in a collective called Wheel of Talk when it came to talk about the problems faced in the daily life, especially on the relationship with babies and relatives. The communications were converging in the sense that the baby needed a reference relationship that would ensure mutual and loving attention. From the interplay between psychoanalysis and the Pikler approach, an intervention model was discussed in the work that aimed to favor both the psychic constitution of the babies and the care of the caregiver. To this end, it was offered to the educators, at that first moment, the said space of speech where the anxieties that the activity of caring aroused were processed and where there was a mutual appropriation of the subtleties of the function that they exercised. Secondly, the research began to be developed in the nursery of the institution and focused, on the one hand, on the observation of the daily relations of care between adults and children, being inspired by the method of observation of the psychoanalyst Esther Bick; on the other, in the narratives of the educators who were selected to be followed in depth and who participated in a conversation with the researcher at the end of each observation. This last activity was based on the clinical construction of the intervention in time and the approach of French psychosociology. In a third moment, the technical team was interviewed, openly and without an instrument of speech, on the internal and external relations of each one. The objective was to understand how these people, as institutional leaders, saw the dynamics of their work and how they exercised it, considering that the social, individual, subjective, intersubjective, conscious and unconscious, imaginary and symbolic dimensions in institutions produce effects on quality of what is produced. In this way, intersubjective relations and their effects on care relationships are at the heart of the research, with the work of B. Golse and D. Stern on the origins of subjectivation as the theoretical axis. As was emphasized in the metapsychological model proposed by Winnicott on the initial carer / baby relations, the psychoanalytic theory on intersubjective / group processes, work psychodynamics and the French psycho-sociological approach. Considering the functions of care as a primordial axis for the process of subjectivation of the babies and for the development of the educator's ability to establish quality bonds with the small ones, the work highlighted the sensitive dimensions of the baby and the adult, and the need for the institutions to consider these invisible elements as a vehicle for the humanization process of all. I conclude that this study corroborates the understanding that for a quality work in the field of baby care to happen it is fundamental that the caregiver has the ability to self-regulate emotionally and to take care of itself. For this, in this time of research, the educators and the technical team have produced a space for the invention of themselves and of the world to which they belong.

La alimentación complementaria: una práctica entre dos saberes / Complementary feeding: a practice between two knowledges

Resumen: Introducción: La alimentación complementaria (AC) comprende un periodo en la vida del lactante que inicia cuando se introducen alimentos diferentes a la leche materna. Está determinada por fac tores sociales y del medio ambiente, que facilitan o limitan el inicio adecuado de esta práctica, inci diendo directamente en el estado nutricional y de salud de los niños. Objetivo: Identificar barreras y facilidades para el seguimiento de las recomendaciones nutricionales en relación al inicio temprano de la AC en niños y niñas entre 0 y 24 meses de edad en una población perteneciente a un programa de atención integral a la primera infancia. Sujetos y métodos: Estudio cualitativo fenomenológico, longitudinal, seleccionando a través de una muestra intencionada 43 madres, a las que se les realizó entrevistas en profundidad y 11 grupos focales. Las categorías predefinidas fueron el contexto de la madre, representaciones y experiencias frente a la gestación, significados y experiencias de la lactan cia materna (LM), y la AC. El análisis comprendió las relaciones entre las unidades de significado y categorías predefinidas y emergentes. Resultados: AC es una práctica social que resulta de la mezcla de saberes médicos y populares, sin embargo, el grado de influencia que tienen estos últimos en las madres es mayor debido al grado de acompañamiento que tienen de su círculo cercano, en especial madres, abuelas y mujeres de la familia. El desconocimiento sobre lactancia materna exclusiva (LME) y AC en términos conceptuales y prácticos, impide que las madres puedan llevar a cabo prácticas ade cuadas. La gran mayoría no tiene claridad sobre lo que implica la exclusividad de la LM, resultando en un inicio temprano de la AC, o no cuentan con criterios objetivos para valorar su producción de leche. A pesar de haber recibido capacitación, la AC inició de manera temprana en la mayoría de los casos, hecho en el que la influencia familiar cercana fue decisiva. Conclusiones: La experiencia de la AC está fuertemente influenciada por el entorno cercano de la madre y las recomendaciones que reciben de profesionales de la salud no son suficientes para transformar sus prácticas. Por lo anterior se hace necesario el mejoramiento de las intervenciones de apoyo en materia de AC.

Abstract: Introduction: The complementary feeding (CF) comprises a period in the life of the infant that starts with the introduction of foods other than breast-milk. It is determined by social and environmental factors which facilitate or limit the appropriate initiation of this practice, directly affecting the nutri tional and health status of children. Objective: To identify barriers and facilities for the follow-up of nutritional recommendations regarding the early start of CF in children between 0 and 24 months of age belonging to a comprehensive early childhood care program. Materials and methods: Phenome nological, longitudinal, qualitative study in which 43 in-depth interviews and 11 focus-groups were carried out. Predefined categories were the context of the mother, representations and experiences of gestation, meanings and experiences of breastfeeding (BF), and CF. The analysis included the rela tionships between the units of meaning and predefined and emerging categories. Results: The CF is a social practice which is the result of medical and popular knowledge mixture, however, the degree of influence that the latter has on mothers is higher due to the degree of support that they have from their close circle, especially from mothers, grandmothers, and women of the family. The lack of con ceptual and practical knowledge about exclusive breastfeeding (EBF) and CF prevents mothers from carrying out good practices. Most of them do not know clearly what is involved in the EBF, resulting in an early start of CF, or do not have objective criteria to assess their milk production. Despite having received specific training, CF started early in most cases, a fact in which close family influence was decisive. Conclusions: The CF experience is strongly influenced by sociocultural aspects not only of the mother but of her immediate circle, and the recommendations they received from health pro fessionals are not enough to change their practices. Therefore, it is necessary to improve CF support interventions.

Representaciones sociales de adolescentes mexicanas embarazadas sobre el puerperio, la lactancia y los cuidados del recién nacido / Social representations of Mexican pregnant teenagers about the puerperal care, lactation, and newborn care

Resumen: Introducción: Los cuidados durante el puerperio y la alimentación del recién nacido están guiados por significados culturales afianzados entre las mujeres, por lo que es importante conocerlos e identificar cómo se adquieren y perpetúan. En este tenor, se estudiaron las representaciones sociales que tienen adolescentes mexicanas embarazadas sobre el puerperio, la lactancia y el cuidado del recién nacido. Métodos: Se realizó un estudio interpretativo basado en los principios de la teoría de las representaciones sociales. Se realizaron entrevistas para obtener información de 30 adolescentes mexicanas que asistieron a control prenatal al área de ginecoobstetricia en un hospital de segundo nivel de atención durante 2015. Se aplicaron estrategias de análisis de contenido clásico para analizar la información; este proceso consistió en codificar y categorizar la información. También se elaboró un mapa conceptual para describir las representaciones sociales encontradas. Resultados: Se identificaron 190 códigos y tres representaciones sociales: «lactancia: práctica mitificada¼, «los recién nacidos son frágiles¼ y «madre e hijo deben sincronizarse¼. Conclusiones: Se identificaron tres representaciones sociales que explicaron las prácticas de las adolescentes hacia la lactancia y el cuidado de ellas y sus hijos, adquiridas mediante la comunicación familiar y afianzadas por la necesidad de apoyo debido a ausencia temporal o permanente de pareja, crisis personales motivadas por los cambios corporales, miedo a sufrir cambios por la lactancia y desconocimiento sobre cómo llevar a cabo la lactancia y los cuidados durante el puerperio.

Abstract: Background: Puerperal care and feeding of the newborn are guided by entrenched cultural meanings between women, so it is important to know and identify how they are acquired and perpetuated. Regarding this knowledge, the social representations that Mexican pregnant teenagers have about puerperium, lactation and newborn care were studied. Methods: An interpretative study was made based on principles of the theory of social representations. Interviews were conducted to obtain information from 30 Mexican adolescents who attended prenatal care at the gynecological obstetrics area in a second-level hospital during 2015. Classical content analysis strategies were applied to analyze the information; this process consisted of coding and categorizing information. A conceptual map was also developed to describe the social representations found. Results: In this study, 190 codes and three social representations were identified: "breastfeeding is a practice based on myths", "newborns are fragile" and "mother and child must be synchronized". Conclusions: Three social representations were identified that explain the practices of adolescents towards breastfeeding and the care of them and their children, which were acquired through family communication and strengthened by the need for support due to the temporary or permanent absence of the couple, personal crises motivated by bodily changes, fear of new modifications due to breastfeeding and ignorance about how carry out breastfeeding and care during the puerperium.

Child care centre adherence to infant physical activity and screen time recommendations in Australia, Canada and the United States: An observational study.

OBJECTIVE: The aim of this study was to compare adherence to physical activity and sedentary behaviour recommendations within the 2011 Institute of Medicine Early Childhood Obesity Prevention Policies as well as screen time recommendations from the 2013 American Academy of Pediatrics for samples of infants in child care centres in Australia, Canada, and the United States (US). METHODS: This cross-sectional study used data from: the Australian 2013 Standing Preschools (N=9) and the 2014-2017 Early Start Baseline (N=22) studies; the 2011 Canadian Healthy Living Habits in Pre-School Children study (N=14); and the American 2008 (N=31) and 2013-2017 (N=31) Baby Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) trials. Data were compared on the above infant recommendations. Percentages were used to describe compliance to the recommendations and chi-square tests to determine whether compliance differed by country. RESULTS: Child care centres were most compliant (74%-95%) with recommendations to: provide daily indoor opportunities for infants to move freely under adult supervision, daily tummy time for infants less than 6 months of age, indoor and outdoor recreation areas that encourage infants to be physically active, and discourage screen time. Centres were least compliant (38%-41%) with adhering to recommendations to: limit the use of equipment that restricts an infant's movement and provide education about physical activity to families. Compared with Canadian and US centres, Australian centres were less compliant (46%) with the recommendation to engage with infants on the ground each day, to optimize adult-infant interactions and to limit the use of equipment that restricts the infant's movement. Canadian centres were less compliant (39%) with the recommendation to provide training to staff and education to parents about children's physical activity. US centres were less compliant (25%-41%) with the recommendations to provide daily opportunities for infants to explore their outdoor environment, limit the use of equipment that restricts the infant's movement and provide education to families about children's physical activity. CONCLUSIONS: Assisting child care centres on limiting the use of equipment that restricts an infant's movement, and providing education about children's physical activity to families may be important targets for future interventions.

O desenvolvimento do bebê e sua complexa relação com determinantes sociais da saúde / The baby development and its complex relations with the social determinants of health / El desarrollo del bebé y su compleja relación con determinantes sociales de la salud

Neste artigo, objetivou-se averiguar a relevância dos Determinantes Sociais da Saúde para o desenvolvimento do bebê com enfoque no desenvolvimento da linguagem. Além disso, realizou-se uma reflexão sobre as contribuições do estudo de casos como forma de adotar uma postura compreensiva e dinâmica na análise do desenvolvimento do bebê. Tais aspectos foram analisados com destaque para a relação de mutualidade mãe-bebê. Para tanto, foram acompanhadas duas díades mãe-bebê filmadas em três etapas da vida dos bebês: entre 20 e 30 dias; entre 80 e 90 dias; e entre 110 e 120 dias. As filmagens foram transcritas e analisadas partindo de fragmentos que ilustram a evolução longitudinal dos casos. Demonstrou-se que esse método de pesquisa permite compreender que os Determinantes Sociais da Saúde incidem de maneira acentuada sobre o desenvolvimento do bebê. Destaca-se que o enfoque na relação mãe-bebê de mutualidade amplia o escopo da atenção materno-infantil e permite verificar a sustentação do cuidado ao bebê por meio da articulação corpo/linguagem. (AU)

This article aims at verifying the relevance of the Social Determinants of Health for infant development focusing on language development. We analyzed the case study contributions as a way to adopt an understanding and dynamic posture in the analysis of infant's development. These aspects were analyzed with emphasis on the mutual mother-infant relationship. For this purpose, we observed two mother-infant pairs filmed in three stages of the babies' life: between 20 and 30 days, between 80 and 90 days, and between 110 and 120 days. The footage was transcribed and analyzed starting from fragments illustrating the longitudinal course of the cases, demonstrating that this method of research allows the understanding of how Health Social Determinants focus on the development of the baby. It stands out that the observation of the mother-infant relationship increases the scope of maternal-infant care and allows checking the support of infant care through the body/ language articulation. (AU)

El objetivo de este artículo consiste en averiguar la pertinencia de los Determinantes Sociales de la Salud para el desarrollo del bebé,con enfoque en el desarrollo del lenguaje. También se realizó una reflexión sobre las contribuciones del estudio de casos, como forma de adoptar una postura comprensiva y dinámica en el análisis del desarrollo del bebé, destacándose la relación mutualidad madre-bebé. Se observaron dos duplas de madre-bebé filmados en tres etapas diferentes de sus vidas: entre 20 y 30 días, entre 80 y 90 días y entre 110 y 120 días. Se transcribieron y analizaron las filmaciones a partir de fragmentos que ilustraban la evolución longitudinal de los casos, demostrando que este método de investigación permite comprender de qué forma los Determinantes Sociales de la Salud, inciden de manera acentuada en el desarrollo del bebé. Se destaca que el foco en la relación de mutualidad madre-bebé amplía el objetivo de atención materno-infantil y permite comprobar el aumento de cuidado con el bebé por medio del lenguaje de articulación cuerpo/lenguaje. (AU)

Os primeiros dias do filho prematuro em casa: discurso do sujeito coletivo / The early days of the premature child at home: collective subject discourse

Objetivo: apreender as representações do pai frente ao cuidado do filho prematuro nos primeiros dias após a alta hospitalar. Método: estudo de abordagem qualitativa. Participaram sete pais que possuíam filhos prematuros hospitalizados em uma unidade de terapia intensiva neonatal. A coleta de dados ocorreu no período de março a junho de 2015. Para análise dos dados, utilizou-se o referencial metodológico do discurso do sujeito coletivo. Resultados: os discursos foram agrupados em três temas: 1) Vivendo as emoções da primeira noite com o filho em casa; 2) Responsabilizando-se pelo cuidado do filho prematuro em casa; 3) Colocando em prática os cuidados aprendidos com a equipe de enfermagem durante a hospitalização. Conclusão: o pai tem participado do cuidado do filh . A equipe de enfermagem deve estar preparada para incentivar a presença do pai no ambiente hospitalar, envolvendo-o nos cuidados precocemente, para que possa sentir-se mais seguro no momento em que estiver com o filho no domicílio. (AU)

Aim: to better understand the experiences of fathers regarding the care of their premature child in the first days after discharge. Method: qualitative approach study. Seven parents participated, who had preterm infants hospitalized in a neonatal intensive care unit. Data collection took place in the period from March to June 2015. For data analysis, the methodological reference of the discourse of the collective subject was used. Results: the speeches were grouped into three themes: 1) Experiencing the emotions of the first night with the child at home; 2) Taking responsibility for the care of the premature child at home; 3) Putting into practice the care measures learned from the nursing team during the hospitalization period. Conclusion: the fathers participated in the care of the child. The nursing team should be prepared to encourage the presence of the father in hospital environments, involving him in the early care practices, so that he can feel more secure when the child is brought home. (AU)

A qualitative study of the infant feeding beliefs and behaviours of mothers with low educational attainment.

BACKGROUND: Infancy is an important period for the promotion of healthy eating, diet and weight. However little is known about how best to engage caregivers of infants in healthy eating programs. This is particularly true for caregivers, infants and children from socioeconomically disadvantaged backgrounds who experience greater rates of overweight and obesity yet are more challenging to reach in health programs. Behaviour change interventions targeting parent-infant feeding interactions are more likely to be effective if assumptions about what needs to change for the target behaviours to occur are identified. As such we explored the precursors of key obesity promoting infant feeding practices in mothers with low educational attainment. METHODS: One-on-one semi-structured telephone interviews were developed around the Capability Opportunity Motivation Behaviour (COM-B) framework and applied to parental feeding practices associated with infant excess or healthy weight gain. The target behaviours and their competing alternatives were (a) initiating breastfeeding/formula feeding, (b) prolonging breastfeeding/replacing breast milk with formula, (c) best practice formula preparation/sub-optimal formula preparation, (d) delaying the introduction of solid foods until around six months of age/introducing solids earlier than four months of age, and (e) introducing healthy first foods/introducing unhealthy first foods, and (f) feeding to appetite/use of non-nutritive (i.e., feeding for reasons other than hunger) feeding. The participants' education level was used as the indicator of socioeconomic disadvantage. Two researchers independently undertook thematic analysis. RESULTS: Participants were 29 mothers of infants aged 2-11 months. The COM-B elements of Social and Environmental Opportunity, Psychological Capability, and Reflective Motivation were the key elements identified as determinants of a mother's likelihood to adopt the healthy target behaviours although the relative importance of each of the COM-B factors varied with each of the target feeding behaviours. CONCLUSIONS: Interventions targeting healthy infant feeding practices should be tailored to the unique factors that may influence mothers' various feeding practices, taking into account motivational and social influences.

Madres descubriendo el amor incondicional en el proceso adaptativo de hospitalización de su bebé prematuro / Mothers discovering the unconditional love in the adaptive process of the hospitalization of your premature infant

Introducción: El nacimiento prematuro tiene un impacto social y emocional para la familia, por lo tanto, enfermería tiene el reto de indagar y profundizar sobre las diversas experiencias; para proponer intervenciones que favorezcan el desempeño del rol materno. Objetivo: Describir los resultados de un metaestudio sobre la adquisición del rol materno de la madre con un recién nacido prematuro hospitalizado. Materiales y Métodos: El metaestudio, involucra 3 fases analíticas: análisis metadatos, meta-método, meta-teoría, consideradas a la luz del contexto histórico, sociocultural y disciplinar. La búsqueda se realizó en: CINAHL, Medline, PsycINFO, Dissertation Abstracts. Resultados: Se incluyeron 26 investigaciones de 13 países publicadas en inglés, portugués y español (durante los años 2001-2013). Las expresiones categóricas que emergen de estas investigaciones, son: pérdida de autocontrol; experimentando dolor; buscando significado a los eventos; adaptándose a la situación; adquiriendo el rol materno y descubriendo el amor incondicional. Discusión: El metaestudio permitió el análisis crítico de la información, orientando la investigación dentro de un contexto de patrones sistemáticos, con la construcción de una alternativa de cambio del enfoque tradicional de pérdida y sufrimiento al del redescubrimiento desde la visión positiva y transformativa. Conclusiones: Reconocer la carga emocional de las madres de recién nacido prematuro obliga al equipo de salud a intervenir e idear estrategias de apoyo, para hacer menos doloroso el proceso de hospitalización de sus hijos. Por ello el cuidado humanizado en la unidad neonatal, debe centrar sus acciones en un cuidado individual, singular, en la integralidad y respeto por la vida.

Introduction: Preterm birth has a social and emotional impact on the family, therefore, nursing is challenged to explore and elaborate on the various experiences; to propose interventions that promote maternal role performance. Objective: To describe the results of a meta-study of the experiences of mothers in the NICU. Materials and Methods: The meta-study involves three analytical steps: analysis metadata, meta-method, meta-theory, considered in light of the historical, sociocultural and disciplinary context. The search was conducted in: CINAHL, Medline, PsycINFO, Dissertation Abstracts. Results: 26 studies from 13 countries published in English, Portuguese and Spanish (in the years 2001-2013) were included. Categorical expressions that emerge from this research are loss of self-control; experiencing pain; seeking meaning to events; adapting to the situation; acquiring the maternal role and finding unconditional love. Discussion: The meta-analysis allowed critical information to guide research in a context of systematic patterns, with the construction of an alternative approach to the traditional exchange of loss and suffering to the rediscovery from the positive and transformative vision. Conclusions: Recognizing the emotional burden of mothers of preterm infants requires the health care team to intervene and devise support strategies to make the process less painful hospitalization of their children. Therefore, humanized care in the NICU, should focus its actions in individual care, singular, in the integrity and respect for life.

Intervenções precoces na infância: observando a relação mãe-bebê em um serviço de saúde / Early intervention in childhood: watching the mother-baby relationship in a health service / Intervenciones precoces en la infancia: observando la relación madre-bebé en un servicio de salud

Este artigo tem como objetivo apresentar as atividades desenvolvidas em um projeto de extensão. Tal projeto visa a observar a relação entre crianças de 0 a 2 anos e suas mães nos atendimentos realizados pelo Programa da Criança em uma Unidade Básica de Saúde, com o intuito de detectar possíveis riscos ao desenvolvimento infantil de modo precoce. Utiliza-se da técnica de observação, tendo por base os Indicadores Clínicos de Risco ao Desenvolvimento Infantil (IRDI). Caso se identifiquem riscos ao desenvolvimento, são utilizados outros recursos técnicos que podem incluir entrevistas de orientações aos familiares e encaminhamentos à rede de atendimentos especializados. Os resultados alcançados indicam a importância do vínculo entre a equipe e os usuários, a maior atenção às díades e suas relações afetivas e a possibilidade de detecção precoce das problemáticas envolvendo os aspectos emocionais. Por fim, destaca-se a ação interdisciplinar e a atuação da Psicologia na promoção de saúde.

This article aims to present the activities developed in an extension Project. Such a project aims to observe the relationship between children, from zero to two years old, and their mothers, in the assistance carried out in the Child Program in a Basic Health Unit, targeting to detect possible early risks to child development. Observation techniques are used, based on the Clinical Risk Indicators in Child Development (CRICD). If risks to development are identified, other technical resources are used, that may include orientation interviews of family members and redirections to specialized services network. Results indicate the importance of the bond between the health care team and the users, the need of greater care regarding dyads and their relationships and the possibility of early detection of problems involving emotional aspects. Finally, the interdisciplinary actions and the role of Psychology concerning health promotion are highlighted.

Este artículo tiene como objetivo presentar las actividades desarrolladas en un proyecto de extensión. Este proyecto pretende observar la relación entre niños de cero a dos años y sus madres en la atención realizada por el Programa Infantil de una Unidad Básica de Salud, con el fin de detectar precozmente los posibles riesgos para el desarrollo del niño. Se utiliza la técnica de observación basada en los Indicadores Clínicos de Riesgo al Desarrollo Infantil (IRDI). Cuando se identifican riesgos para el desarrollo, otros recursos técnicos son utilizados, que pueden incluir entrevistas de orientación a los familiares y derivaciones a la red de atención especializada. Los resultados obtenidos indican la importancia del vínculo entre el equipo y los usuarios, una mayor atención a las duplas y sus relaciones afectivas y la posibilidad de detección precoz de los problemas que afectan a los aspectos emocionales. Por último, se destaca la acción interdisciplinaria y la actuación de la Psicología en la promoción de la salud.

Differences in breast-feeding initiation and continuation by maternal diabetes status.

OBJECTIVE: To examine (i) the prevalence of and associations between breast-feeding initiation and continuation by maternal diabetes status and (ii) the reasons for not initiating and/or continuing breast-feeding by maternal diabetes status. DESIGN: Secondary data analyses of a population-based cross-sectional study were conducting using data from the US Centers for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System (PRAMS), 2009-2011. Multivariable logistic regression was used to investigate the associations between breast-feeding initiation and continuation by diabetes status. SETTING: Thirty states and New York City, USA. SUBJECTS: Mothers of recently live-born infants, selected by birth certificate sampling. RESULTS: Among 72755 women, 8.8 % had gestational diabetes mellitus (GDM) and 1.7 % had pregestational diabetes mellitus (PDM). Breast-feeding initiation was similar among GDM and no diabetes mellitus (NDM) women (80.8 % v. 82.2 %, respectively, P=0.2), but continuation was lower among GDM (65.7 % v. 68.8 %, respectively, P=0.01). PDM women had lower initiation and continuation compared with NDM (78.2 %, P=0.03 and 60.4 %, P<0.01, respectively). In adjusted analyses, current smoking status was a significant effect modifier for initiation, but not for continuation. CONCLUSIONS: Differences in breast-feeding initiation and continuation prevalence by maternal diabetes status may reflect differences in prenatal education, indicating the need for increased efforts among PDM women. Additionally, non-smoking women with PDM or GDM would benefit from additional breast-feeding education.

Percepções maternas sobre o nascimento de um filho prematuro e cuidados após a alta / Maternal perceptions about the birth of a premature child and care after discharge / Percepciones maternas sobre el nacimiento de un hijo prematuro y cuidados después del alta

Estudo qualitativo que objetivou conhecer percepções maternas sobre o nascimento do filho prematuro e os cuidados após a alta. Os dados foram coletados por meio de entrevista semiestruturada com 16 mães de prematuros internados em UTIN, ou em acompanhamento pelo ambulatório de seguimento de recém-nascidos egressos de UTIN. As entrevistas foram gravadas, transcritas e interpretadas com base na Análise de Conteúdo. Os resultados revelaram sentimentos de tristeza, angústia, culpa e impotência. Registrou-se, ainda, confiança na equipe de saúde, insegurança com os cuidados ao filho em casa, a importância da rede de apoio social e da espiritualidade para as famílias. Profissionais que trabalham com prematuros devem dedicar maior atenção às suas famílias, compreendendo experiências críticas e acolhendo de forma humanizada.

This is a qualitative study, which aimed to identify maternal perceptions on premature birth and care of the newborn during hospitalization and after discharge. The data were collected through semi-structured interviews with 16 mothers of premature infants in NICU or in follow up ambulatory for infants discharged from NICU. The interviews were taped, transcribed and analyzed based on Content Analysis. Results revealed feelings of sadness, anguish, guilt and powerlessness. It was also reveled confidence in the health care team, uncertainty with the care of child at home, the importance of social network support and the role of spirituality for families. Professionals who work with infants should devote more attention to their families, understanding and accepting critical experiments in a humane way.

Investigación cualitativa con el objetivo de conocer la percepción materna sobre el nacimiento prematuro e el cuidado del recién-nacido durante la hospitalización e después del alta. Los datos fueron tomados mediante entrevista semi-estructurada a 16 madres con hijos prematuros internados en la UTIN o en la supervisión del seguimiento del ambulatorio para niños prematuros dados de alta de la UCIN. Las entrevistas fueron grabadas, transcritas y analizadas sobre la base de Análisis de Contenido. Los resultados revelaron sentimientos de tristeza, angustia, culpa e impotencia. Se registró también la confianza en el equipo de salud, la incertidumbre con el cuidado del niño en el hogar, la importancia de la red de apoyo social y de la espiritualidad para las familias. Los profesionales que trabajan con niños deben prestar más atención a sus familias, comprendiendo y aceptando los experimentos críticos de una manera humana.

O início do desmame precoce: motivos das mães assistidas por serviços de puericultura de Florianópolis/SC para esta prática / Early weaning: motives for this practice of mothers attending an infant welfare service in Florianopolis/SC, Brazil

Objetivo: Identificar as razões das mães de crianças de 6 a 12 meses de idade, em acompanhamento de puericultura na cidade de Florianópolis/SC, para a interrupção do aleitamento materno exclusivo (AME) antes do sexto mês pós-parto (início do desmame precoce). Método: Estudo transversal de características descritivas, realizado a partir de entrevistas guiadas por um questionário, aplicado a 100 mães que realizaram consultas de puericultura no Hospital Universitário da Universidade Federal de Santa Catarina (HU - UFSC) e em outras 100 mulheres que o fizeram na Unidade de Saúde do Saco Grande II (USSGII), entre janeiro e abril de 2005, totalizando uma amostra de 200 mães. Os dados foram analisados e as variáveis classificadas em categorias através da análise do significado e redução das respostas. Em seguida foram organizados com o programa Epi Info 3.5 e apresentados por meio da estatística descritiva (distribuições absolutas e percentuais). Resultados: O aleitamento materno foi realizado por 98% da amostra; entre as mães que amamentaram, 18,4% realizaram aleitamento materno exclusivo até o sexto mês de vida do seu filho. O desmame foi iniciado de forma precoce por 81,6% das participantes, sendo que 46,2% dessas mães o fizeram motivadas por conceitos pessoais, 35,6% relataram algum problema relacionado à saúde do bebê, 27,5% em função dos múltiplos papéis desempenhados pela mulher-mãe, 19,4% alegaram algum problema orgânico pessoal e 18,7% o realizaram por orientação de alguém. Conclusão: A influência cultural e familiar, o trabalho materno e problemas de saúde da mãe e do bebê foram determinantes para o início do desmame precoce.

Objective: To identify the reasons why mothers of children aged 6 to 12 months attending an infant welfare service in Florianopolis/SC, Brazil interrupted the exclusive breastfeeding (EBF) before the sixth month postpartum (beginning of early weaning). Methods: A cross-sectional study with descriptive and analytical characteristics was conducted based on questionnaire-guided interviews proposed to 100 mothers who had routine infant welfare visits at the University Hospital of the Federal University of Santa Catarina (HU - UFSC) and other 100 mothers who did so at the Saco Grande II Public Health Unit (USSGII), between January and April 2005, a total sample of 200 mothers. Data were analyzed and the variables were classified into categories by examining the meaning and the reduction of responses. The data were organized by EpiData version 3.1 and processed electronically by public domain software Epi Info - version 3.5. Results: Breastfeeding was reported by 98% of the sample. Among the mothers that breastfed, 18.4% did it exclusively until the infant reached six months. Early weaning was reported by 81.6% of the sample; 46.2% of them were motivated by their own concepts, 35.6% reported infant-related problems, 27.5% attributed to the multiple tasks assigned to a woman-mother, 19.4% reported a personal systemic problem, and 18.7% followed an advice from someone else. Conclusion: Cultural and familial influence, maternal work and maternal and infant health problems were determinant factors for early weaning.

Use of a video-ethnographic intervention (PRECESS Immersion Method) to improve skin-to-skin care and breastfeeding rates.

PURPOSES: Skin-to-skin care after birth often is absent, interrupted, or delayed for routine procedures. The purposes of this project were to improve skin-to-skin care and exclusive breastfeeding at hospital discharge. METHODS: For Part 1, we used a descriptive observational design, with video-ethnography and interaction analysis (PRECESS-Practice, Reflection, Education and training, Combined with Ethnography for Sustainable Success), during a 5-day quality improvement pilot study in a U.S. hospital (August 13-17, 2010). For Part 2, we used electronic health record review to test for differences in monthly rates of skin-to-skin care and exclusive breastmilk feeding (baseline, July 2010; post-intervention, August-December 2010). RESULTS: In Part 1, 11 mothers and babies participated: 10 (91%) received immediate skin-to-skin care, eight (73%) received uninterrupted skin-to-skin care, nine (82%) planned to breastfeed, six (67%) of these babies were exclusively breastfeeding at hospital discharge, and five (83%) of the six babies who completed all nine instinctive stages during skin-to-skin care were exclusively breastfeeding at hospital discharge. In our subsequent review (Part 2), we found a significant improvement (25% above baseline) in the overall rate of skin-to-skin care across post-intervention months (Pearson χ(2)=23.798, df=5, p<0.000), predominantly from improvements in the cesarean section population. The rates of exclusive breastfeeding showed no significant change. CONCLUSIONS: The PRECESS immersion method may help to rapidly improve skin-to-skin care. Babies who undergo all nine stages during skin-to-skin care may be more likely to exclusively breastfeed. Mothers need support during skin-to-skin care to recognize their baby's readiness to breastfeed. Skin-to-skin care during cesarean surgery may reduce maternal stress and improve satisfaction with the surgical experience.

Domestic maternal experience with preterm newborn children / Vivência materna domiciliar com recém-nascido prematuro / Experiencias maternas en el hogar con recién nacidos prematuros

Objective Exploring maternal experience with premature newborn children in a domestic environment. Methods The study was qualitative and used focus group interviews with 24 women who had had preterm deliveries in a public maternity hospital located in Northeast Brazil during June and October 2005. The mothers returned to the hospital facility at least 30 days after the newborn were discharged to share their experiences in caring for a premature infant at home. Results Interview data was analysed for content, four thematic nuclei being identified: hospital discharge, preparing the family for discharge, caring for a premature baby at home and life changes arising from the premature birth. The greatest difficulties reported by the mothers in caring for their premature children at home were related to feeding and feelings of insecurity and fear were expressed which showed the need for a support network for the families following discharge. Conclusions The mothers care of premature infants at home represented changes for parents in everyday family life, work and social life, thus showing the need for a support network for them during the transition from hospital to home when considering premature children.

Objetivo Explorar as vivências maternas no cuidar de um recém-nascido prematuro em casa e analisar as dificuldades na assistência materno-infantil, após a alta hospitalar dos prematuros. Métodos Estudo descritivo de natureza qualitativa com utilização do grupo focal com 24 mulheres que tiveram partos pré-termos em uma Maternidade escola, referência estadual para gestação de alto risco no nordeste brasileiro, no período junho a outubro de 2005. As mulheres retornaram ao serviço no período mínimo de 30 dias após a alta do neonato para relatar suas experiências de como cuidavam do recém-nascido prematuro em casa. Resultados Os conteúdos das entrevistas foram divididos em quatro núcleos temáticos: A alta hospitalar; o preparo da família para a alta; cuidando de um bebê prematuro no domicílio materno e, mudanças na vida impostas pelo nascimento prematuro. As maiores dificuldades apresentados pelas mães no cuidado com o filho prematuro em casa dizem respeito à  alimentação e resultaram das falhas da equipe de saúde no preparo dessas famílias para os cuidados domiciliares com o prematuro. Surgiram ainda sentimentos de insegurança e medo, revelando a necessidade de uma rede de apoio com seguimento ambulatorial e de pronto atendimento para oferecer suporte à s famílias de bebês prematuros após a alta. Conclusões No cuidado materno com o filho prematuro no domicílio predominaram sentimentos negativos que impuseram mudanças no cotidiano familiar, no trabalho e na própria vida social, revelando a necessidade de apoio aos pais na transição da vida hospitalar para domiciliar em situação de prematuridade.

Objetivo Explorar las experiencias maternas con recién nacidos prematuros en el entorno domiciliario. Métodos Estudio cualitativo que utilizó un grupo focal con 24 mujeres que tuvieron partos prematuros entre junio y octubre de 2005 en una maternidad pública en el noreste de Brasil. Las madres regresaron a la instalación al menos 30 días después del alta del parto para compartir sus experiencias en el cuidado de un recién nacido prematuro en el hogar. Resultados Cuatro núcleos temáticos fueron identificados: el alta hospitalaria, la preparación de la familia para la aprobación de la gestión, el cuidado de un bebé prematuro en el hogar y los cambios en la vida como resultado del nacimiento prematuro. Las mayores dificultades seà±aladas por las madres en el cuidado de sus nià±os prematuros en el hogar estaban relacionados con la alimentación y se expresaron sentimientos de inseguridad y temor, lo que demuestra la necesidad de una red de apoyo a las familias después del alta. Conclusión El cuidado de la madre del recién nacido prematuro en el hogar representa para los padres cambios diarios en la familia, el trabajo y la vida social, mostrando la necesidad de una red de apoyo para ellos durante la transición del hospital a la casa en una situación de prematuridad.

Etnoteorias parentais: um estudo com mães residentes no interior e na capital de Santa Catarina / Parental ethnotheories: a study with mothers living in the capital and countryside of Santa Catarina State

O estudo teve como objetivo investigar etnoteorias parentais em mães residentes na capital e interior de Santa Catarina. Foram aplicadas escalas de crenças sobre práticas de cuidado, metas de socialização e alocentrismo familiar em 50 mães de cada contexto cultural. Os resultados na capital indicaram predomínio de elementos autônomo-relacionais em práticas e alocentrismo familiar, enquanto que em termos de metas, as mães valorizaram a autonomia da criança. No interior, no que se refere a metas de socialização e alocentrismo familiar, foram identificados aspectos relacionais. Contudo, em termos de crenças sobre práticas de criação, constatou-se maior valorização da autonomia. Concluiu-se que ambos os contextos caracterizam-se por um modelo de self autônomo-relacional, embora com diferentes ênfases de acordo com a dimensão investigada.

The aim of this study was to investigate parental ethnotheories of mothers living in the capital city and in the countryside of Santa Catarina State. In each cultural environment, fifty mothers were interviewed based on scales that evaluated their beliefs about childrearing practices, socialization goals and degree of familism. Results from the capital demonstrated a predominance of autonomous-related elements for practices and familism, whereas in terms of socialization goals, mothers valued the autonomy of the child. In the countryside, relational aspects were identified for socialization goals and familism. However, for beliefs about childrearing practices it has been noted emphasis on autonomy. The conclusion was that both contexts are characterized by an autonomous-related self, although with different emphases according to the dimension investigated.